Inhaled Epoprostenol for an Intermediate-High-Risk Pulmonary Embolism With an Aortic Intramural Hematoma

Intermediate-high-risk pulmonary embolism (PE) is typically treated with anticoagulation. However, reperfusion therapy may be contraindicated when bleeding risk is high. We describe a 72-year-old man with a type B aortic intramural hematoma who presented with bilateral pulmonary emboli, hypoxemia, elevated troponin and NT-proBNP levels, and right ventricular strain. Thrombolysis was contraindicated due to concerns about hematoma expansion, and thrombectomy was deferred because the patient remained hemodynamically stable and invasive intervention was considered high risk. He received unfractionated heparin and adjunctive inhaled epoprostenol. Oxygen requirements, right ventricular findings, and cardiac biomarkers improved, although the contribution of inhaled epoprostenol could not definitively be determined.